Cone-beam CT with dedicated planning software improves the range of optimal gantry angles for prostate artery embolization

Introduction: A major challenge of prostate artery embolization (PAE) is intraprocedural prostate artery identification. Combined cone beam computed tomography (CBCT) with automatic vessel segmentation software can be used in the IR suite to more clearly identify the prostate artery’s origin. This study evaluates the optimal gantry angle for PAE determined by CBCT and automatic segmentation software compared to the traditional ipsilateral 25 to 55-degree oblique angle recommended by previously established PAE guidelines. Methods: A single Interventional Radiologist (IR) performed twenty-one PAEs using CBCT with Embo ASSIST software (GE Healthcare, Chicago, IL) to generate twenty-one 3D models of pelvic arterial anatomy. The prostatic artery was confirmed with combined selective digital subtraction angiography and CBCT. Each identified prostate artery was classified based on the de Assis/Carnavale system. In a retrospective, case-controlled experimental design, three IRs independently reviewed the twenty-one different 3D models to determine the optimal gantry angle and laterality to visualize the prostatic artery. Results: A majority of prostatic arteries (48%) were type 1 based on de Assis/Carnavale classification. Approximately 16% of PAE cases had an optimal gantry angle within the recommended ipsilateral 25 to 55-degree range. The optimal gantry angle was contralateral in 51% of cases. The mean gantry angle to optimally visualize the prostatic artery was 3 degrees contralateral to the side of prostate artery embolization. Conclusion: Augmenting existing PAE gantry and image acquisition best practices may improve knowledge of patient anatomy and minimize radiation doses to the IR and patient.